Provider Demographics
NPI:1730248030
Name:JANOVSKY, MOLLY B (APRN-BC, CWOCN)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:B
Last Name:JANOVSKY
Suffix:
Gender:F
Credentials:APRN-BC, CWOCN
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 MACARTHUR BLVD
Mailing Address - Street 2:WOUND OSTOMY CLINIC
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2901
Mailing Address - Country:US
Mailing Address - Phone:219-836-7713
Mailing Address - Fax:219-836-7083
Practice Address - Street 1:901 MACARTHUR BLVD
Practice Address - Street 2:WOUND OSTOMY CLINIC
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2901
Practice Address - Country:US
Practice Address - Phone:219-836-7713
Practice Address - Fax:219-836-7083
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000171A364SM0705X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201001140Medicaid